Nursing as a profession - part 1

Unit III- Nursing as a profession part 1. Includes defintion, characteristics,scope , functions, qualities and categories of nurse. Also included is a brief history of nursing field.

1. By SAILI GAUDE ASST. PROFESSOR JCN BHANDU NURSING AS A PROFESSION 1

2. HISTORY OF NURSING Illness earlier was seen as “magic”, “sin” or “punishment”. During 700-600 B.C - Sushruta Samhita was written by the great surgeon Sushruta , who said "the physician, the patient, the drugs and the nurse are four feet of `Padas' of the medicine, upon which the cure depends". The first nursing school started in India in 250 B.C. during Charaka's time and only men were considered pure enough to be nurses. 2

3. history   300 AD Entry of women into nursing. 1633 -Sisters of Charity founded by Louise de Marillac -established the first educational program to be affiliated with a religious nursing order 1809 -Mother Elizabeth Seton introduced the Sisters of Charity into America, later known as the Daughters of Charity.

4. 1836 -Deaconess Institute of Kaiserwerth , Germany, founded -institute where Florence Nightingale received her initial education in nursing  1860 -establishment of the Nightingale Training School for Nurses at St. Thomass Hospital in London, England -first organized program for training nurses 4

5. DARK PERIOD OF NURSING - From 17th century – 19th century. Also called the Period of Reformation until the American Civil War. Hospitals were closed. Nursing were the works of the least desirable people (criminals, prostitutes, drunkards, slaves, and opportunists). Nurses were uneducated, filthy, harsh, ill-fed, overworked. 1854 - 1856 (CRIMEAN WAR)- On Oct. 21, 1854, Nightingale left with 38women for the Crimean War—Made rounds at night with a lamp “Lady of the Lamp”. Compiled the “Notes on Nursing: What it is and What is not” and became the first nurse theorist. British casualties were high; within 6 months, death rate cut in half.

6. HISTORY   1884 - Mary Snively assumed directorship of Toronto General Hospital and began to form the Canadian National Association of Trained Nurses. Later became the Canadian Nurses Association. 1890 - establishment of the Nurses Associated Alumni of the United States and Canada & this later became the American Nurses Association.

7. history 1901 - first university affiliated nursing program, Army Nurse Corps established . 1901 - New Zealand was the first country to regulate nurses nationally, with adoption of the Nurses Registration Act on the 12 September 1901. It was here in New Zealand that Ellen Dougherty became the first registered nurse. 1911 - formed American Nurses Association. 7

8. 1920 - graduate nurse-midwifery programs were established. 1948 - Brown report says all nursing programmes must be affiliated to the university, should have independent budget. 1960 – Yale University defined Nursing as a Profession. 8

9. In the ancient era, until 17th century, formalized nursing was not traced. Every village had a dai /traditional birth attendant to take care of maternal and child health needs of the people. 9

10. Military nursing was the earliest type of modern nursing introduced by the Portuguese in the 17th century. 1664 - East India Company started a hospital for soldiers at Fort St. Geroge , Madras. St. Stevens Hospital at Delhi was the first one to begin training Indian women as nurses in 1867. 10

11. The first school of Health visitors was started in 1918 by Lady Reading Health School, Delhi. 1946 - The first four-year Basic B.Sc. program was established at RAK College of Nursing in Delhi and CMC College of Nursing in Vellore. 1951 - a two-year ANM course was established in St. Mary’s Hospital at Punjab. 1960 - M.Sc. was established in RAK College of Nursing, Delhi. 11

12. 1963 - the School of Nursing in Trivandrum, instituted the first two-year post certificate bachelor's degree programme . 1980 - RAK college of nursing started an MPhil programme as a regular and part time course. Doctorate Of Philosophy In Nursing (PhD in Nursing. PhD programmes in nursing was first started in India in 1992 under Department of Nursing, University of Delhi through RAK. 12

13. 13 1890 - Bombay Presidency Nursing Association was the first state nursing association. 1908 - the Trained Nurses Association was formed to uphold the dignity and honor of nursing profession. The first state registration council at Madras Nursing Council was constituted in 1926 and Bombay Nursing Council was constituted in 1935. In 1949, Indian Nursing Council (INC) was established to maintain a uniform standard of training for nurses, midwives and health visitors and regulate the standards of nursing in India. INC act was passed in 1947 that was amended in 1950 and 1957. 2003 - The College of Nursing PGI, Chandigarh and College of Nursing, CMC Vellore were designated as WHO collaborating centers for nursing and midwifery development. NURSING COUNCILS –

14. NURSING “LET US NEVER CONSIDER OURSELVES FINISHED NURSES… WE MUST BE LEARNING ALL OUR LIVES.” - Florence Nightingale 14

15. definition “ The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery , that he would perform unaided if he had the necessary strength, will or knowledge.” - VIRGINIA HENEDERSON (1966) 15

16. SIX ESSENTIAL FEATURES OF PROFESSIONAL NURSING 1. Provision of a caring relationship that facilitates health and healing. 2. Attention to the range of human experiences and responses to health and illness within the physical and social environment. 3. Integration of objective data with knowledge gained from an appreciation of patient or group’s subjective experiences. 16

17. 4. Application of scientific knowledge to the processes of diagnostic and treatment through the use of judgment and critical thinking. 5 . Advancement of professional knowledge through scholarly enquiry. 6. Influence of social and public policy to promote social justice. -ANA (2003) 17

18. NURSING AS A PROFESSION 18

19. PROFESSION A group must meet the following criteria to be considered a profession (Starr, 1982) 1. the knowledge of the group must be based on technical and scientific knowledge. 2. the knowledge and competence of memebers of the group must be evaluated by a community of peers. 3. the group must have a service orientation and a code of ethics. 19

20. PROFESSIONAL NURSE Professional nurse is a graduate of a recognized nursing school who has met the requirements for a registered nurse in a state in which she is licensed to practice. 20

21. CRITERIA FOR PROFESSION FULFILLED BY NURSING 1.High intellectual level of functioning 2.High level of individual responsibility and accountability 3.Specialized body of knowledge 4.Evidence based nursing practice 5.Public services and altruistic activities. 21

22. 6.well organized and strong representation. 7. code of ethics 8.competencies and professional license. 9. autonomy and independent practice 10. Professional Identity And Development 22

23. High intellectual level of functioning Modern nurses use assessment skill and knowledge, have the ability to reason and make routine judgment depending on patient’s condition. Professional nurses functions at a high intellectual level. Florence nightingale raised the bar for education and graduates of her school were considered to be highly educated. 23

24. 2.high level of individual responsibility and accountability Nurses must be accountable and demonstrate a high level of individual responsibility for the care and services they provide. The concept of accountability has legal, ethical and professional implications that include accepting responsibility for action taken to provide client care as well as accepting responsibility for the consequences of action that are not performed. 24

25. 3.specialized body of knowledge Nursing has developed into an identifiable separate discipline, a specialized body of knowledge called as nursing science. It was compiled through the research effort of nurses with advanced educational degrees. Although this body of specialized knowledge is relatively small, it forms a theoretical basis for the practice of nursing today. 25

26. 4.evidence based nursing practice Evidenced based practice is the practice of nursing in which interventions are based on data obtained from research that demonstrate that, the findings are appropriate and successful. It involves a systematic process of uncovering, evaluating and using information from research as the basis for making decisions about providing client care. 26

27. 5.public services and altruistic activities. Individual is the focal point of all nursing models and nursing practice. Nursing has been viewed universally as being an altruistic profession composed of selfless individuals who place the lives and well being of their clients above their personal safety. Dedicated nurses provide care for victims of deadly diseases with little regard for their own welfare. 27

28. 6.well organized and strong representation. Professional organizations represent the members of the profession and control the quality of professional practice. In India TNAI & SNA are the two organizations that represent nursing in today’s health care system. Many do belong to specialty organizations that represent a specific area of practice. 28

29. 7. code of ethics A code of ethics document may outline the mission and values of the business or organization, how professionals are supposed to approach problems, the ethical principles based on the organization's core values and the standards to which the professional is held. Some of the ethical principles are autonomy, justice, non- maleficence 29

30. 8.competencies and professional license. Nurses must pass a national licensure examination to demonstrate that they are qualified to practice nursing. Only after passing the examination the nurses are allowed to practice. The granting of a nursing license is a legal activity conducted by the individual state under the regulations contained in the state’s nursing practice act. 30

31. 9. Autonomy And Independence Of Practice: In reality nursing is both an independent and interdependent discipline. Nurses in all health care setting must work with physicians, hospital administrators, pharmacists and other groups in the provision of care. To be considered a true profession, nursing will need to be recognised by other disciplines as having practitioners who practice nursing independently. 31

32. 10. Professional Identity And Development: Until nurses are fully committed to the profession of nursing, identify with it as a profession and are dedicated to its future development, nursing will probably not achieve professional status. 32

33. CONCEPTS IN NURSING . 33

34. CONCEPT The art and science of modern nursing encompasses fundamental nursing concepts that include health, illness, stress and health promotion. Nurses work with physicians and other medical staff in a wide variety of medical and community settings. • They provide preventive, primary, acute and chronic care for sick and injured patients with health information, restorative care, medication administration and emergency care. Nursing care focuses on protecting and promoting physical and mental health for patients and for the community 34

35. 35 Health is the absence of illness, injury and disease. Health as a fundamental nursing concept involves both mental and physiological well being, and it changes over a patient's lifetime. Nurses work in health care to promote and protect health by instructing patients about self-care, and about how lifestyle and behavior affects their health. They help people to recover from physical and mental illness, and they tend to sick and injured patients to restore health. Concepts of Nursing- Health:

36. 36  Illness is a fundamental nursing concept that defines a deviation from health with three stages: the onset of illness, the acceptance of the state of illness and the convalescence or recovery stage. A nurse’s role in illness includes monitoring and interpreting symptoms, administering medication and self-care information, and caring for patients who are incapacitated by illness. Concepts of Nursing- Illness:

37. 37 Nurses work to make patients more comfortable, and a big part of nursing care includes reducing patient stress. Nurses explain procedures to patients, listen to patient concerns and answer questions, protect patients' privacy and ask how patients are feeling. The goal is to calm them and make them feel more physically and emotionally comfortable. Concepts of Nursing- Stress:

38. 38 It’s the responsibility of every nurse to promote better health by informing patients of things such as illness prevention methods, safe health practices and healthy lifestyle choices. Nurses promote health by discussing weight and exercise issues, nutrition, the risks of drinking, smoking and drug use, and other self-care that increases their quality and length of life. Concepts of Nursing- Health promotion:

39. PHILOSOPHY The study of the fundamental nature of knowledge, reality, and existence, especially when considered as an academic discipline. A theory or attitude that acts as a guiding principle for behavior. Nursing is viewed as both an art and a science, reflecting upon the concepts of the nursing. Nursing is an applied discipline which expresses itself in practice, and has its foundation rooted in scientific/empirical knowledge, theory, and research. Nursing is also expressed as a caring, therapeutic and teaching discipline. The goal of nursing is optimum client wellness, and the maximum level of functioning. The nursing interventions are evidence-based and stem from their core knowledge. The professional nurse must appreciate the role of informatics. 39

40. Objectives of Nursing Maintain and promote wellness, prevent illness, care for and rehabilitate the sick of disabled through the human science of nursing. Reduce stress. Provide comfort to the client during diseases process. Provide service to individual families and societies. Work independently with other health workers assisting the client to gain independence as quickly as possible. Develop interaction between nurse and client. Focus on a man a living unity and man’s qualitative participation with experience. 40

41. Characteristics of Nursing Nursing is caring. Nursing involves close personal contact with the recipient of care. Nursing is concerned with services that take humans into account as physiological, psychological, and sociological organisms. Nursing is committed to promoting individual, family, community, and national health goals in its best manner possible. 41

42. Nursing is committed to personalized services for all persons without regard to color, creed, social or economic status. Nursing is committed to involvement in ethical, legal, and political issues in the delivery of health care. 42

43. Functions of a nurse 1.Caregiver The caregiver role has traditionally included those activities that assist the client physically and psychologically while preserving the client’s dignity. Caregiving encompasses the physical, psychosocial, developmental, cultural and spiritual levels. 43

44. Functions of a nurse 2.Communicator Communication is an integral to all nursing roles. In the role of communicator, nurses identify client problems and then communicate these verbally or in writing to other members of the health team. The quality of a nurse’s communication is an important factor in nursing care. 44

45. Functions of a nurse 3. Teacher : As a teacher, the nurse helps clients learn about their health and the health care procedures they need to perform to restore or maintain their health. The nurse assesses the client’s learning needs and readiness to learn, sets specific learning goals in conjunction with the client, enacts teaching strategies and measures learning. 45

46. Functions of a nurse 4.Client advocate Client advocate acts to protect the client. In this role the nurse may represent the client’s needs and wishes to other health professionals, such as relaying the client’s wishes for information to the physician. They also assist clients in exercising their rights and help them speak up for themselves. 46

47. Functions of a nurse 5. Counselor Counseling is a process of helping a client to recognize and cope with stressful psychologic or social problems, to developed improved interpersonal relationships, and to promote personal growth. It involves providing emotional, intellectual, and psychologic support. 47

48. Functions of a nurse 6.Change agent •The nurse acts as a change agent when assisting others, that is, clients, to make modifications in their own behavior. Nurses also often act to make changes in a system such as clinical care, if it is not helping a client return to health. •Researcher ,rehabilitator,& critical thinker. 48

49. Functions of a nurse 7.Leader • A leader influences others to work together to accomplish a specific goal. Effective leadership is a learned process requiring an understanding of the needs and goals that motivate people, the knowledge to apply the leadership skills, and the interpersonal skills to influence others. 49

50. Functions of a nurse  8.Manager • The nurse manages the nursing care of individuals, families, and communities. The nurse-manager also delegates nursing activities to ancillary workers and other nurses, and supervises and evaluates their performance. 50

51. Functions of a nurse 51 9.Case manager Nurse case managers work with the multidisciplinary health care team to measure the effectiveness of the case management plan and to monitor outcomes.

52. CATEGORIES OF NURSING PERSONEL 52

53. HOSPITAL 53

54. SCHOOL OF NURSING 54 COLLEGE OF NURSING

55. 55 End of lecture